Precertification Specialist I - Pre-access - Days

Memorial Hospital at Gulfport•Biloxi, MS

About The Position

The Precertification Specialist I verifies patient demographics and insurance benefits, ensures authorizations for services are in place, and informs patients of estimated payment amounts. The role maintains a resource schedule and serves as a liaison among patients, providers, physicians, and insurance companies. The specialist completes assigned pre-admission processes, monitors schedules for added tests or procedures, documents account information and follow-up needs, performs financial processes, prepares charge estimates, and collects pre-payments when necessary. The role also communicates payment options, monitors authorization status, supports reimbursement for services involving non-MHG providers, and works with providers to modify orders to meet payer medical-necessity guidelines.

Requirements

High school diploma or GED equivalent.
Minimum of one year of previous clerical experience.
Knowledge of admitting procedures, insurance coverage, and billing requirements.
Knowledge of general office procedures and equipment.
Knowledge of billing and collections regulations.
Proficiency with general office equipment and Microsoft Office applications.
Skill in preparing and maintaining records, files, and reports.
Ability to perform data entry with minimal errors.
Ability to work independently and as part of a team.
Effective oral and written communication skills.
Ability to multitask and prioritize.

Nice To Haves

Certification or vocational training.
Two to four years of relevant experience.

Responsibilities

Ensure the completeness and integrity of patient registration.
Verify and document patient demographics, guarantors, and insurance information.
Validate correct insurance at registration and maintain an error rate of 4% or less.
Complete pre-admission processes specific to the assignment.
Monitor schedules for assigned areas for added tests or procedures.
Document accounts with pertinent information, including follow-up needed by hospital personnel.
Perform financial processes and communicate the patient's financial responsibility.
Create charge estimates based on available information and collect pre-payments when necessary.
Communicate financial options to patients before testing and refer patients to Financial Counselors when appropriate.
Screen testing urgency based on the patient's ability to pay.
Balance cash sheets and perform audits.
Ensure MHG financial policy qualifications are met.
Monitor authorization status and alert Provider Staff or a Precertification Specialist II if authorization has not been received at least three days before the date of service.
Obtain copies of authorizations for non-MHG providers to receive reimbursement for MHG.
Communicate with providers to modify testing or procedure orders to a medically necessary diagnosis based on payer guidelines.